Why all the doulas need a doula, and what to do about it

This article was first published elsewhere in Oct 2023.

Inspired by the recent State of The Midwifery Workforce episode on The Great Birth Rebellion podcast, today I want to share some reflections on the state of the postpartum doula workforce.

In the podcast episode, hosts Mel and B and their expert guests speak to data collected on the Australian midwifery workforce, which indicates a high percentage of early career midwives (those with 0-5 years clinical experience), but an average staff age of 47 years. This is not to say most Australian midwives are graduating and commencing practice in their 40s, but that the majority of midwives are either very newly qualified and entering the workforce (mostly in their 20s) or very experienced and nearing retirement age (and may no longer be practicing in a clinical capacity but holding other roles).

Midwifery is a predominantly female/AFAB profession, and midwives of childbearing age have been departing the workforce in recent years - the factors contributing to this are discussed in the episode, and I will not rehash them here. This trend has been exacerbated by the pandemic and the combination of paid working conditions and unpaid mothering demands related to it. There is a shortage of midwives in every state and territory of Australia1 and the midwifery workforce here, they say, as it is across the globe, is in crisis.

The promo vision. Photo by Alexander Grey on Unsplash

On the one hand this makes sense: most doulas are mothers or birth parents, and who knows better what the babymakers of the 2020s need than the babymakers of the 2020s? Often when our own babies are small we are down the rabbit hole of consuming every scrap of fertility, pregnancy, loss, birth, postpartum and parenting information anyway, so why not follow our current area of passion and expertise into a vocation? It feels uplifting to help other parents, to build the community around families we see as lacking, and to do our part to share our growing wisdom and improve the mental health of mothers which we know (usually from personal experience) can be pretty shit. The idea of not having to drag yourself to a less than inspiring job post-mat leave and being able to choose your own hours3 is mighty appealing too. The online advertising for doula courses targets femme-presenting people around my age, so it must be a perfect time to join the fold, right?

Maybe so, but on the other hand, a postpartum doula workforce consisting of mothers and birth parents of very young children makes close on no sense at all. As Stephanie H. Murray writes in The Atlantic:

“The earliest years of parenting are most demanding of time and energy, most likely to cause “role overload,” and most disruptive to one’s sleep, work, and marriage.”

I have written a whole book about how and why so many modern day mums feel broken, guilty, overwhelmed and angry. We are the ones who bear the brunt of kid sicknesses and are most likely to carry our household’s caring, practical and mental loads. We may be recovering from previous births and trauma, or be pregnant again ourselves. As one of the most strung out, harried, depleted collectives in our societies we should be the ones receiving care, and yet we are the primary group signing ourselves up to provide it to our peers.

I understand the drive towards this vocation at this time of life. I started my postpartum doula training when my first baby was under six months old4. I told myself I would return to my previous job at 11 months postpartum two days per week, and gradually build up my doula business enough on the side until I could quit my employment. Where I thought the child care was coming from for this I’m not sure, but that was my intention. The pandemic and my sleep-hating, sensitive AF baby had other plans, but I wish someone (other than my mum, who tried to warn me and I of course did not listen) had told me I had rocks in my head.

My eldest is now 4.5 years old, and my second baby is close on 1. I supported a couple of in-home clients between lockdowns and babies, but generally, it was not sustainable work for this period of my life.5 Yes, my birth mapping, birth debriefing, postpartum planning and motherhood support skills have been put to good use in private sessions over the years, and I love hosting workshops and mothers’ circles. Still, I sometimes wish for a postpartum doula to help with my baby, let me rest and cook me meals on the hard days, not the other way around. When I’m in a good patch, I do what I can practically for my local friends with babes in tow, but I honestly don’t know when I’ll feel up to being an in home, hands on, reliable for weeks on end, all-in-let-me-envelope-you-in-love postpartum doula for someone else again. I know I’m far from the only one in this position, and it’s hard to build the profile of your profession if half your workforce is on maternity, sick or personal/carer’s leave at any given time.

This all sounds pretty dire for the doula workforce, but I have an idea that’d kill two birds with one stone.

Rather than thinking about those of us with little babes right now, let’s shift our focus for a moment to the wellbeing of women a decade or two older, so those aged 45-676. According to the McKell Institute’s Women in Work: A story of exclusion report,

“older women are excluded from the workforce at an alarming rate.”

The authors note that while much public debate about women’s workforce involvement centres on early years child care provision, the greatest disparity between men’s and women’s employment rates are recorded in the 45-49 year age group. It is when their children are older and women are trying to return to the workforce after an extended break they are most likely to be excluded, the authors say, a trend which is observed even moreso in regional locations compared to metro areas.

The effects of women’s historical and current unemployment and underemployment are contributing factors in what has been described as “tsunami of older women on the verge of experiencing homelessness”. A 2020 report indicated a whopping 405 000 Australian women aged over 45 were considered at risk of houselessness, a number which has likely risen with rising costs of rents and other essentials.7 Women aged 50 and over also report higher rates of loneliness than men, which comes with its own raft of health issues, again potentially linked to lesser workforce participation and therefore incidental social interaction.

It seems there is a group of women who want to work but are excluded from the workforce, need more than $802.50/fortnight to live8, have years of parenting and housekeeping experience, would benefit from meaningful social interaction and live in locations where existing postpartum support provisions are inadequate…

Yes B2, I think I am!

What about we stop recruiting postpartum doulas who are in the thick of postpartum themselves, and pivot our attention towards those a half to full generation above us?! Surely this would help those who are interested (and able9 to perform this kind of work) in more ways than one. More of us in the parenting trenches would get the support we need too. It would increase the potential for intergenerational connectedness many can’t access due to living far from their own family or strained relationships, and move support work work into actually available (potentially even overnight!), experienced, reasonably priced, practical hands and into the houses that need it rather than keeping it restricted to the white wellfluencer/culturally appropriative Instagram display home world. By the time this cohort are ready to retire or pare back their hours, we’ll be out of the hot zone of babyland and be able to step in to work where people actually know and value what we do. Everybody wins!

Genius, right?!

Here are some ideas on how we could make it happen:

1. Shift advertising doula training courses from femme-presenting people in their 30s to those in their 50s. Explain the job and why they’d be ace at it. Change the wording, change the images, change the age groups targeted on Facebook advertising.

2. Set aside scholarships (full or partial) and make payment plans for older women re-entering the workforce. Hand them out like candy!

3. Add “Parent Support Professional” to the National Priority Skills List (I’m thinking a rename would help people get what this kind of work is as separate from birthwork or babysitting and get it across the line and widen the scope to include extended postpartum parent care). This would mean the workforce can be assessed for shortages and if (read: when) one is reported, training can be subsidised 75% by the government up to $2200.10

4. Assist older women to access small business set up support services and grants in their area like these ones to transition from doula course to practice. We can’t expect women to know how to draw up a contract without industry experience, or cover start up costs like insurance if they’re living below the poverty line.

5. Stop over-complicating what it takes to offer postpartum care from a business point of view. I’ve written about my tips before, but I think even I made it sound harder than it really is. If you’re doing in home care without any online work, you’d really only need your passionate and trained self, an ABN, a draft contract, an insurance policy, a Facebook page (to avoid paying for a website), an email address and a letterbox drop to get started.

6. Make connecting parent support professionals to potential clients easier. Maybe some bright spark reading this could set up an agency to connect those who need services with those who can offer them in more streamlined ways than the current hodge podge of the doula grapevine and Facebook groups currently on offer, as well as take care of things like contracts and bookkeeping. I’d also love to see parent support people for at-risk families included in care that can be arranged by case workers and funded through Non For Profit organisations, either in home or at neighbourhood centres if the client’s home isn’t an appropriate environment. It’d be awesome to have the government subsidise or rebate care provided by all older, early career doulas in their first year or two of practice, like mature age apprentice wages are in trade-based (and historically male) industries.

7. Invite older women who are training or working as early career doulas to participate in courses like Triple P Parenting and Circle of Security that are already (often) available to freely to parents. This would help move older women training as parent support professionals beyond the advice given to them in their baby-raising days, and introduce current evidence-based ways of supporting children and families to those who might not yet be aware of the changes.

Sounds good, huh? How we get the ball rolling on this kind of undertaking I’m not sure. I’m the ideas woman for this party, not the event manager, so if you know which doors to knock on or who to send this on to please do! I’m also going to leave comments open for everyone on this post because I reckon you’d have thoughts on this - what do you see about current doula age grouping, availability and workforce issues? What else could we do or add to this mix that haven’t I thought of?

It might sound pie in the sky but dreams have gotta start somewhere. But really though, how good would it be…

Anna x

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